Healthcare Provider Details

I. General information

NPI: 1306462437
Provider Name (Legal Business Name): MOLLY MYRL MILBOURN GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10730 NALL AVE STE 201
OVERLAND PARK KS
66211-1210
US

IV. Provider business mailing address

10730 NALL AVE STE 201
OVERLAND PARK KS
66211-1210
US

V. Phone/Fax

Practice location:
  • Phone: 913-945-7000
  • Fax: 914-945-9860
Mailing address:
  • Phone: 914-945-7000
  • Fax: 913-945-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79466-092
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: